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Original Research
Understanding sexual violence: Perspectives from an adolescent HIV prevention study
Submitted: 06 August 2024 | Published: 17 September 2025
About the author(s)
Nadia Ahmed, Department of Genito-Urinary Medicine, Central North West London NHS Trust, London, United Kingdom; and, Faculty of Health Sciences, Desmond Tutu HIV Foundation/Centre, University of Cape Town, Cape Town, South AfricaEmily Webb, Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
Richard Muhumuza, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
Andrew S. Ssemata, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
Millicent Atujuna, Faculty of Health Sciences, Desmond Tutu HIV Foundation/Centre, University of Cape Town, Cape Town, South Africa
Lynda Stranix-Chibanda, Clinical Trials Research Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe; and, Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
Teacler Nematadzira, Clinical Trials Research Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
Janan J. Dietrich, Perinatal HIV Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Gugulethu Tshabalala, Perinatal HIV Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Stefanie Hornschuh, Perinatal HIV Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Helen A. Weiss, Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
Janet Seeley, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda; and, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; and, Department of Social Science, Africa Health Research Institute, Durban, South Africa
Julie Fox, Department of Infectious Diseases, Faculty of Medicine, Kings College London, London, United Kingdom
Abstract
Background: Sub-Saharan Africa has a high prevalence of sexual violence in young women, with less data on young men.
Aim: We investigated the prevalence of forced sex among adolescents and young people and described factors putting them at risk of sexual violence.
Setting: The study was conducted in South Africa, Uganda and Zimbabwe.
Methods: We conducted a cross-sectional, structured survey among 1330 13–24-year-old male and female participants. Logistic regression models were used to estimate odds ratios for associations with forced sex, adjusting for site, sex and age. Sixty in-depth interviews and 24 group discussions were also conducted. Data were transcribed, translated and analysed using thematic framework analysis.
Results: Seventy-six out of 1326 participants (6%) reported forced sex in the last 6 months. Forced sex was most commonly reported in Entebbe versus other sites, female than male participants, and 18–24 years than 13–18 years. Associations were seen with younger sexual debut (adjusted odds ratio [aOR]: 0.89; 95% confidence interval [CI]: 0.81, 0.98), ever having transactional sex (aOR: 2.18; 95% CI: 1.19, 4.02), risk-taking (aOR: 3.51; 95% CI: 1.99, 6.19), depression (aOR: 3.20; 95% CI: 1.69, 6.06), anxiety (aOR: 2.07; 95% CI: 1.08, 3.96) and binge drinking (aOR: 2.66; 95% CI: 1.33, 5.36), and strong association with forcing someone to have sex (aOR: 7.54; 95% CI: 3.68, 15.46). Qualitative data support these results.
Conclusion: Our findings identify risks similar to those for sexual violence.
Contribution: We suggest protection strategies to police times and places of risk are developed, and addressed in economic and legal country specific guidance.
Keywords
Sustainable Development Goal
Metrics
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